Zosyn over 4 hrs

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Specializes in Med/Surg, LTAC, Critical Care.

At my hospital we used to infuse Zosyn (2.225, 3.375, and 4.5GM) mixed with 50mL of NS over 30 minutes. Recently our hospital has changed protocol to infuse 3.375GM with 100mL of NS over 4 hrs. At first it was just for renal patients with off the wall BUN/Creatine levels, now it is protocol for every patient receiving Zosyn. They say that the therapeutic levels stay in the system longer. I like to verify things myself, but after consulting Almighty Google, I am having trouble finding any science behind this. It makes sense to me, but I just like seeing the data for myself. I am weird.

Anybody heard anything about this?

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At our hospital we give Zosyn 3.375 in 115 ml over 2 hours. Don't have a rationale, sorry.

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My hospital has adopted the same thing ... IIRC before it was 3.375 Q6 over 30 min, but when they changed it they made it Q8.

The only problems *I* have with this is that Zosyn hasn't been tested for compatibility for anything, ergo in order for you to do this, you absolutely need a dedicated IV site for this infusion.

It's nice when they have triple lumens and/or have no other IV meds, but w/ CVL BSI protocols / docs being wary of keeping CVL's in place, and typically folks on Zosyn are a bit more ill, not running into issues is becoming few and far between.

Our typical people to get Zosyn are infected lower extrem ulcerations, which means their vasulature is sometimes not the best... Makes that infusion all that much more special.

We do have the ability in a pinch to override this and continue on the former infusion if we're waiting for a CVL / PICC and need to infuse multiple things.

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Specializes in med surg/cardiac.

We give over 30 minutes but with 6 hour frequency. Of course if you give over 4 hours it will be therapeutic longer. Isnt that true with any med? Just like if you drink your case of beer over 4 hours you will be theapeutically tipsy longer. :devil: But my question is why dont they change to an abx with a longer half life? Or increase the freqency of zosyn? I didnt notice how often you infuse. Sounds like just a huge inconvienence for the nurse to have to schedule meds around it or start a new IV site and the patient to be hooked up to the pump for that long...

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never heard of that.

we typically give it in 100ml over an hour...pretty much like everything else except vanco

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Specializes in Med/Surg, LTAC, Critical Care.

We used to infuse q6h over 30 minutes. Now its q8h over 4 hrs. The major downside someone already mentioned: Alot of times these people already have Vanc, Maxipime, Rocephin, and god knows what else inaddition to the primary line of NS, D5, or whatever the doc things looks good that week.

God bless the inventor of the triple lumen PICC line:D.

On a side note, pratically every person that comes into the ED gets Rocephin, at least a 1 time infusion. Dang near everybody with pneumonia or any kind of infxn gets Zosyn. Aside of Maxipime, it's the most common one here.

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They are doin it at some of the hospitals here in AZ.

No idea why.

Received a pt from a local hospital receiving zosyn 4.5 Q6 infusing over 4 hrs for CRF.

After a long discussion it was decided no matter how slow you infuse the med if you are infusing the same exact amount over the 6hr period what does it matter?

We asked if you want to dose for CRF then lower the dose, our pharmacy agreed. 2.25 Q6 over 30 minutes was the verdict.

Have not heard of any reactions to Zosyn infusions, not sure if there is the Red Man's Syndrome with Vanco equivalent in the Zosyn arena.

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According to the National Institute of Health it recommends infusion over 30 minutes. Over 40 minutes if renal impairment is present.

http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=4558

Has a table of drug levels over 6hrs.

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Specializes in Med-Surg.

The hospital I work at has been infusing zosyn over four hours for about two years now. We learned that this practice results in a better therapeutic drug level for the patient. Seems to be driven by evidence based practice. If you're really interested in the science behind it, ask a pharmacist!

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They suggested to run Zosyn over 4 hours for those patients who are not renal impaired (or patients with at least a creatinine clearance of 20 or over) to maintain its sensitivity specially to the gram (-) organisms. maintaining its minimum inhibitory concentration will actually help the infection and avoiding

some organisms getting immune to it.

But since it is excreted in the kidneys, pt on any form of dialysis, increased creatinine levels and clearance will remain to get it over 30 min. I heard that E.D. can give it over 30 minutes as prescribed.

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I recently travelled to a hospital with the 4 hr policy in place. I questioned a pharmacist about the policy- one of his replies probably drives the policy as much as any other. It allows administration of 3 doses per day instead of 4. Since hospitals are reimbursed by diagnoses anything that cuts costs is more profitable to the hospital. As long as the treatment is as effective why not save the hospital money? By the way, we did admin over 30 minutes in the ER. The pharmacist stated they would adjust when pt was in-patient

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I am a nursing student finishing up my last semester in the program and I am actually doing a research project on this! These articals may help:

Pharmacokinetics of piperacillin-tazobactam: intermittent dosing

versus continuous infusion.

Steady-state pharmacokinetics and pharmacodynamics of

piperacillin/tazobactam administered by prolonged infusion in

hospitalised patients.

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